Organization
CENTRAL MINNESOTA ORTHODONTICA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLY AM NORDIN (BUSINESS MANAGER)
(320) 255-1111
Entity
Organization
Contact information
Practice address
1411 W SAINT GERMAIN ST, SUITE 104, SAINT CLOUD, MN 56301-4121
(320) 255-1111
(320) 255-1602
Mailing address
1411 W SAINT GERMAIN ST, SUITE 104, SAINT CLOUD, MN 56301-4121
(320) 255-1111
(320) 255-1602
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
11705
MN
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
8228
MN
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
D12904
MN
Other
Enumeration date
12/05/2006
Last updated
08/19/2011
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